Robotic approaches for male infertility and chronic orchialgia microsurgery

Abstract

Long-term prospective controlled trials are necessary to assess the true benefit for robotic-assisted microsurgery. The preliminary findings are promising, but further evaluation is warranted.

The evolution and refinement of vasoepididymostomy techniques

“…Early studies in animal model 34,35 using LIVE demonstrated a 100% patency rate. The group from Parekattil et al 36,37 has reported one of the earliest series of human robotic microsurgical VE. Using again LIVE, Parekettil et al 36,37 reported a significant decrease in the operating time with the robot (mean 120 min; range 50-180 min) compared to the non-robotic microsurgical method (150 min; range 120-240 min).…”

“…The group from Parekattil et al 36,37 has reported one of the earliest series of human robotic microsurgical VE. Using again LIVE, Parekettil et al 36,37 reported a significant decrease in the operating time with the robot (mean 120 min; range 50-180 min) compared to the non-robotic microsurgical method (150 min; range 120-240 min). They also reported an earlier return of sperm with the robotic technique compared to the non-robotic method, although the postoperative total motile sperm counts of the two methods were not significantly different.…”

“…Parekattil et al 37 noted several benefits of robotic surgical microsurgery: (i) a stable, ergonomic, scalable control system with threedimensional visualization and magnification; (ii) simultaneous ability to control three instruments and a camera; (iii) ability to integrate up to three visual inputs simultaneously in the surgeon console; and (iv) decreased fatigue and obviate the need for a skilled surgical assistant. Additional advantages of the robotic LIVE include improved stability and motion reduction during microsurgical suturing, 34 which may be in part related to shorted operating time observed.…”

“…Additional advantages of the robotic LIVE include improved stability and motion reduction during microsurgical suturing, 34 which may be in part related to shorted operating time observed. 37 It should, however, be pointed out that the availability of robotic is far from being universal in most parts of the world and that the cost-effectiveness of this approach remains to be established. Additional disadvantages such as Figure 5 The corpus and caudal epididymis can be dissected off from the testis tunica albugenia and brought superiorly to bridge a massive vasal gap.…”

Robotic assisted andrological surgery

“…In 2008, our group introduced the use of robotic assistance for targeted microsurgical denervation of the spermatic cord (RMDSC) for patients with chronic groin or testicular pain. 9,10 The initial inertia in the use of robotics in microsurgery has primarily been a lack of access to the robot by microsurgeons and the 10-fold increase in cost of the equipment in comparison to standard microsurgical equipment. However, our group has recently published a larger volume study comparing robotic to pure microsurgical vasectomy reversal and have shown that with increased volume, enhanced surgical efficiency, eliminated need for a skilled microsurgical assistant, and decreased operative time, these procedure can be performed at a cost similar to or even less than standard microsurgical procedures.…”